Objective — This research concerns those patients who most attend the community Mental Health Centre (CSM), hereby called «everyday patients». According to a previous research (Pileggi et al., 1992) a sample of patients mostly attending the Centre had been pointed out. Basing on the number of attendances, it emerged that some of those patients (57) had been on the average attending the Centre more than twice a week and, despite being only 10% of the total number of users, they had taken on a large share of the services offered by the Centre (30%). Therefore, those patients were the ones the Centre had been working for more intensely and continuously. Three years later, the object of this research is to check the assistance and clinical destiny of such patients and compare their patterns of attendances to those ones regarding the remainder of the CSM users. The hypothesis is that «everyday patients» are assisted by different and continuous treatments and that such a procedure prevents patients from dropping out and determines a strong reduction in relapses and less frequent attendances. Design — Longitudinal study on a 42 patient sample (19 males, 23 females) on therapy at CSM. Setting — Mental Health Centre, «Saragozza» District, Sanitary Unit of Bologna. Main outcome measures — The following elements have been examined: 1) social and demographic features; 2) duration of psychiatric history; 3) clinical diagnosis according to DSM-HI-R, set by patients personal psychiatrist; 4) global functioning level as examined by two psychiatrists or psychologists from the Centre, using DSM-III-R Global Functioning Scale (GFS); 5) actions carried out and patterns of using the CSM services over the past 12 months. Concordance measures among independent examiners (Cohen K) and non-parametric variability measures for comparison between groups (Chi-square and Kruskal-Wallis tests) have been used. Results and conclusion — Results partially confirm the original hypotheses. In particular, complicated services (psychological and pharmacological therapies and rehabilitation) are carried out for the most of «everyday patients» and much more intensely to them than to the remainder of the users. No drop-out has been found out, the global functioning level of the patients is good in most of cases and the number of necessary admissions to psychiatric wards has been reduced. However, the «attendance share» relevant to the sample of «everyday patients» is still high compared to the total number of the CSM users. Besides, discharge rate is nought.

Objective — Eighteen years after the 1978 reform law no. 180, psychiatric services have to find new roles and goals in the social arena, in order to continue to effectively pursue the improvement of mental health in the commi nity. The aim of the present paper is to show some theoretical and practical elements that could stimulate in the psychii trie services a deep consideration about the relationship between psychiatric services and «private social» bodies, part cularly social co-operatives and voluntary organisations. Method — The elements shown in this study come from an ani lysis: a) of the literature about the crisis factors of the Italian welfare state, particularly in the Public Health Service and i the social assistance; b) of the literature about the development of the «private social» and about the relationship with tl public services; c) of national and regional laws, particularly of Veneto region; d) of the present experiences in Sout Verona Psychiatric Service. Results — The crisis of the traditional welfare state, the emergence in large sectors of gener; population of needs related to social fragmentation and relational impoverishment, the aspiration of a great number (individuals excluded from society to benefit of the right to full citizenship, all this urgently questions the traditional roh and responsibilities, the organisation, operational modalities, and the community orientation of existing health and hi man services. Within this framework, the relationship between psychiatric services (or, broadly speaking, public serviet in general) and «private social» bodies, particularly social co-operatives and voluntary organisations, has become part of a foreseeing, strategic new awareness of mental health workers. Conclusion — A shift from a relationship of mutual exploitation between organisations, to one of co-operation between them, each considering the other as an equal partne may be a critical step forward a new model of welfare. This, in turn, would hopefully meet the needs for health of th population in terms of efficiency, quality, relevance and consideration of the users' resources and social competencies.

Objective — To asses the capacity of the Parental Bonding Instrument (PBI) to discriminate between normal subjects and clinical samples and between with different psychiatric diagnosis. Design — The present paper analyzes the studies published between 1979 and 1995, which have used the PBI in normal subjects and clinical samples and have reported the respective means and standard deviations obtained on the two PBI dimensions: affection and control. Multiple comparisons were carried out between the mean scores of affection and control of: 1) samples with the same psychiatric diagnosis (intragroup comparison); 2) samples with different psychiatric diagnoses (intergroup comparison); 3) normal subjects and clinical samples. Results — Of the 46 studies with normal and clinical subjects, 23 studies were selected for the analysis, reporting means and standard deviations and specifying the diagnostic criteria. Samples with the same psychiatric diagnosis had similar affection and control scores. With the exception of bipolar affective disorders and avoidant personality disorders, the prevalent parental style was for all diagnostic groups the affectionless control style. Within the affectionless control style, the PBI discriminated between panic attacks, borderline personality and drug addiction but not between schizophrenia, unipolar depression and anxiety disorder. The PBI discriminated also between normal subjects samples and samples with anxiety disorder, schizophrenia, bipolar affective disorder, personality disorder and drug addiction respectively. Conclusion — The results confirm previous suggestions from single studies that the perceived parental style as measured by the PBI can be considered a good predictor for the presence of psychiatric disorders excluding panic attacks, avoidant personality disorders and unipolar affective disorders. Although the different diagnostic groups do not differ in their perceived parental style (affectionless control), significant differences between some diagnostic groups within this category suggest that the PBI might have some specificity as well.

Objective — The implementation of a simple methodology to estimate full costs of services provided by a public mental health centre. Setting. CPS (NHS Mental Centre) Ussl 35, Magenta, Lombardy Region. Method — To estimate full costs of 16 types of service we followed a two step procedure. The first step was to estimate all costs attributable to the CPS. In the second one, we allocated this estimate to each type of service provided. We attributed to the CPS the following cost items: personnel, utilities (telephone, electricity, water, heating and cleaning), land & building, transports (for services provided outside the clinic) and a share of general cost of the USSL to which the CPS belongs. Full cost of each service was then calculated on the base of the yearly number of services provided and the time spent by each health professional. Results — In 1995, the CPS provided 14, 562 services. Total costs amounted to L 1,356 million, and more than three quarters of this amount was attributable to the personnel working at the CPS. Unit costs ranged from L 5,300 (drug administration) to L 442,400 (family therapy involving two professionals for 90 minutes) The unit cost of psychiatric visits, psychologist consultations and nurse domiciliary visits were L 105,300, L 106,600 and L 78,000, respectively. Conclusions — This approach requires accessible data and is relatively simple to manage. Some refinements are required, especially to improve the methodology for the determination and the allocation of overheads. However, we are convinced that this cost accounting procedure provides acceptable estimates of the services provided by the CPS. These estimates suggest that charges to be used to fund NHS providers may be too low, especially if fee-for-service will be the main funding source.